Ask women about partner violence, panel says

NEW YORK (Reuters Health) - Doctors should screen all of their female patients for signs of partner violence, whether face-to-face or through a waiting room questionnaire, a new report suggests.

The review of the current evidence on screening for partner abuse, from researchers at Oregon Health & Science University in Portland, is the first step toward new recommendations on screening from the government-sponsored United States Preventive Services Task Force.

According to the Centers for Disease Control and Prevention, close to three in 10 U.S. women have experienced rape, stalking or physical violence by a partner. Other studies suggest as many as half of women will experience psychological aggression from an intimate partner at some point in their lives.

In the new analysis, researchers found the possible harms of screening -- such as women feeling uncomfortable or depressed -- are small, and the potential benefits include catching cases of past or current partner violence and referring women for help.

"By even asking a few questions, it sends a message to patients that this is something they can talk about with their doctor," Dr. Heidi Nelson, the study's lead author, told Reuters Health.

There's still more that can be learned, for example, about the right questions to ask and the right setting to ask them in to get to the heart of any abuse.

But bringing up the topic may be what's most important, no matter how it's done, said Ping-Hsin Chen, who has studied domestic violence screening at the University of Medicine & Dentistry of New Jersey in Newark.

"As long as we screen for domestic violence, patients will be willing to talk to doctors or medical staff or to answer questions about it," Chen, who wasn't involved in the new report, told Reuters Health.

Nelson and her colleagues found that six of the different screening tools used in prior studies were "highly accurate" at figuring out which women were experiencing intimate partner violence, according to the review, published Monday in the Annals of Internal Medicine.

Most of those tools involved just a few questions either on a questionnaire or part of a doctor-patient conversation, such as: "In the past year, have you been afraid of a partner?"

Some but not all studies on possible interventions suggested that counseling -- by social workers, psychologists or mentors -- helped those women avoid violence in the future.

The USPSTF's recommendations are expected soon, Nelson said. The panel's last recommendations on the topic, in 2004, determined there wasn't enough evidence to recommend for or against screening women without symptoms -- like evidence of physical abuse -- for partner violence.

Chen said that in her experience, many doctors are taught how to screen for signs of partner violence -- but not as many know what to do next, in terms of helping women avoid abuse in the future.

"I think the most important thing is talking to them about a safety plan," she told Reuters Health. "Especially during pregnancy, they might not be able to leave their partner," or they might not be in a frame of mind where they're ready to take that step.

Nelson agreed that the right response from a woman's primary care doctor or a social worker will need to be tailored to her current situation.

"A woman who maybe has a past history of abuse and is still struggling with that... has a different set of needs than a woman who is worried that today, she might be in danger," she said.